1078. The Benefit of Two-Way Communication between Public Health and the Provider Community: The Fungal Infection Outbreak in Tennessee
Session: Poster Abstract Session: Surveillance of HAIs: Implementation and National Perspectives
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: On September 18, 2012, the Tennessee Department of Health (TDH) was notified of a case of aspergillus meningitis in an immunocompetent patient following an epidural steroid injection at an outpatient neurosurgical clinic.  Further cooperation between Tennessee clinicians, infection preventionists, laboratory personnel, TDH and the Centers for Disease Control (CDC) was critical in identifying the broader outbreak of fungal infections among recipients of epidural glucocorticoid injections.

Methods: An ongoing partnership between TDH and the private healthcare system in Tennessee was leveraged to allow for abstraction of procedure information on the exposed cohort to identify the cause of the outbreak.  Remote access to patient medical and laboratory records was provided to relay relevant medical information on cases to TDH and CDC to assist in determining the spectrum of illness and to help develop interim treatment guidelines.

Results: By September 26, the methylprednisolone acetate (MPA) linked to the outbreak had been voluntarily recalled.  TDH was provided remote access to the electronic medical record (EMR) system at 14 hospitals in Tennessee with the potential to admit exposed patients. On October 3, TDH described the clinical characteristics and provided interim treatment guidance for cases in an alert through the Tennessee Health Alert Network.  Of the 15 cases at the time, 14 presented with severe or worsening headache, 7 with fever, 6 with vomiting, and 1 with nuchal rigidity. White blood cell counts in the cerebrospinal fluid were greater than 1,000 in all 15 cases.  TDH also hosted clinical calls involving multiple disciplines (e.g. infectious disease, neuroradiology, and neurosurgery) to discuss diagnosis and treatment across the state.

Conclusion: The infrastructure and relationships between the state health department and Tennessee’s clinical community were essential to timely identification of the first cases linked to epidural steroid injections.  Ease of communication between clinicians and TDH staff (including remote EMR access) helped to identify the causative exposure and describe the spectrum of illness.  Real time review of case medical records was instrumental in the development of interim treatment guidelines throughout the course of the outbreak.

Andrew Wiese, MPH, Brynn Berger, MPH, CIC, Jennifer Ward, MS, Meredith Kanago, MSPH, Jea-Young Min, PharmD, MPH and Marion a. Kainer, MBBS, MPH, Tennessee Department of Health, Nashville, TN


A. Wiese, None

B. Berger, None

J. Ward, None

M. Kanago, None

J. Y. Min, None

M. A. Kainer, None

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